The brain is made up of 3 main parts:
  1. Cerebrum is divided into 4 lobes with specific functions:
    • Frontal lobe controls reasoning, emotions, problem solving, speech and movement.
    • Parietal lobe controls the sensations of touch, speech, visual-spatial orientation and calculation.
    • Temporal lobe controls memory, hearing, and the ability to understand spoken or written words.
    • Occipital lobe controls vision.
  2. Cerebellum is located at the back part of the brain and is responsible for coordination and balance.
  3. Brain stem controls involuntary functions like the heart beat and breathing. Messages from the cerebrum and cerebellum travel through the brain stem to the body.

Brain cancer treatment in Malaysia


Primary brain tumors

Primary brain tumor starts in the brain is often described as low or high grade. A higher grade is usually more aggressive and more likely to grow quickly. Primary brain tumors are divided into glioma and non-glioma tumor types.

Gliomas arise from brain glial cells and can be categorized as astrocytoma, oligodendroglioma, or ependymoma. Non-glioma tumors arise from non-glial cells and can be categorised as meningioma, pineal and pituitary gland tumours, primary CNS lymphomas, medulloblastoma, craniopharyngioma and schwannoma.


Secondary brain tumors

Secondary brain tumors or brain metastases are more common than primary tumors. Secondary brain tumors originate from another part of the body such as the breast, lung, kidney, colon, skin and spreads to the brain.

If cancer spreads to the meninges and the cerebrospinal fluid (CSF), it is called leptomeningeal metastases.



General and specific symptoms include:
  1. Headaches
  2. Seizures
  3. Personality or memory changes
  4. Nausea or vomiting
  5. Drowsiness
  6. Changes in ability to perform daily activities
  7. Loss of balance and difficulty with fine motor skills
  8. Changes in judgment, speech, comprehension, hearing and emotional state
  9. Partial or complete loss of vision, altered sensation and power on one side of body
  10. Difficulty swallowing, facial weakness or numbness


How a brain tumor is diagnosed

Imaging tests can determine if the tumor is a primary or secondary brain tumor.

Magnetic resonance imaging (MRI): The MRI may be of the brain and/or spinal cord, depending on the likelihood that it will spread in the CNS.

Tissue sampling/biopsy of tumor: A sample of the tumor’s tissue is usually needed to make a final and definitive diagnosis.

CT scan: A CT scan identifies bleeding and enlargement of the fluid-filled spaces in the brain, called ventricles. Changes to bone in the skull as well as tumor size can also be seen on a CT scan.

Positron emission tomography (PET): A PET scan is used at first to find out more about a tumor while a patient is receiving treatment. It may also be used if the tumor comes back after treatment.

Biomarker testing of the tumor: This may also be called molecular testing of the tumor. Results of these tests will determine your treatment options.

- For oligodendroglioma, a 1p/19q co-deletion is linked to more successful treatment, particularly with chemotherapy.
- Mutation in the isocitrate dehydrogenase (IDH) gene, is found in about 70% to 80% of low-grade gliomas and is linked with a better prognosis in both low-grade and high-grade tumors.
- In glioblastoma, mutation in methyl guanine methyl transferase (MGMT) gene is linked to prognosis and how well treatment will work.


How a brain tumor is treated

Targeted therapy

In addition to standard chemotherapy, targeted therapy targets the tumor’s specific genes, proteins, or the tissue environment that contributes to a tumor’s growth and survival.

To find the most effective treatment, our Oncologist will run tests to identify the genes and proteins in your tumor.

For a brain tumor, there are 2 types of targeted therapy that may be used:
  1. Anti-angiogenesis therapy is used to treat glioblastoma multiforme, newly diagnosed with IDH mutation or when previous treatment has not worked. Anti-angiogenesis therapy is focused on stopping angiogenesis, which is the process of making new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapy is to “starve” the tumor.
  2. NTRK inhibitor focuses on a specific genetic change called an NTRK fusion. These drugs are approved to treat some brain tumors that are metastatic or cannot be removed with surgery and have worsened with other treatments.

A variety of other targeted therapies are being studied in brain tumors that contain other specific molecular changes, such as IDH mutations, BRAF mutations, and FGFR fusions.

Please click here to learn more about Targeted Therapy

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. It is often the only treatment needed for a low-grade brain tumor. Removing the tumor can improve neurological symptoms; provide tissue for diagnosis and genetic analysis.

Radiation therapy
External-beam radiation therapy can be directed at a brain tumor in the following ways:
  1. Conventional radiation therapy.
  2. 3-dimensional conformal radiation therapy (3D-CRT).
  3. Intensity modulated radiation therapy (IMRT). IMRT is a type of 3D-CRT (see above) that can more directly target a tumor. It can deliver higher doses of radiation to the tumor while giving less to the surrounding healthy tissue.
  4. Proton therapy. Proton therapy is a type of external-beam radiation therapy that uses protons rather than x-rays.
  5. Stereotactic radiosurgery. Stereotactic radiosurgery is the use of a single, high dose of radiation given directly to the tumor and not healthy tissue. It works best for a tumor that is only in 1 area of the brain and certain noncancerous tumors. It can also be used when a person has more than 1 metastatic brain tumor.


Treatment by brain tumor type


For people with grade II or III oligodendroglioma with a 1p/19q co-deletion and an IDH genetic mutation, ASCO recommends radiation therapy in combination with the chemotherapy drugs, which together are called PCV.


ASCO recommends that people with grade II astrocytoma with an IDH genetic mutation and no 1p/19q co-deletion be offered radiation therapy followed by chemotherapy with either oral chemotherapy or PCV. People with grade III astrocytoma with an IDH genetic mutation and no 1p/19q co-deletion should be offered radiation therapy followed by oral chemotherapy or both of these treatments given at the same time. Likewise, people with grade IV astrocytoma with an IDH genetic mutation may be offered radiation therapy followed by oral chemotherapy or both of these treatments given at the same time. Some astrocytomas without an IDH mutation may be treated the same way as grade 4 glioblastoma that also does not have an IDH mutation.


For most people with newly diagnosed grade IV glioblastoma or a grade II or III astrocytoma and no IDH genetic mutation, ASCO recommends treatment with radiation therapy and oral chemotherapy given at the same time. After this treatment, 6 months of oral chemotherapy is recommended.

Patients and their families have opportunities to talk about the way they are feeling with our oncologists, nurses, counselors, or join our psychosocial program and support group at Onco Life Centre.

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